ER-/PR-/HER2+ treatments

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mom2LA
mom2LA Member Posts: 4
edited May 2021 in Stage IV/Metastatic Breast Cancer ONLY

I was diagnosis Breast cancer (left) in January 2018, IDC, ER-,PR-,HER2+. 8 positive nodes. I had THCP 6 cycles, mastectomy (left and right), radiation. After that I had Herceptin and Perjeta for 1 year. I thought i am done. In June 2019, scan found I had superclavicular, mediastinal, and hilar lymph nodes. I then started weekly taxol until June 18, 2020. Taxol resolved these nodes. However, later Scan found that I had groundglass opacities in my lung. I then started Kadcyla in June 25, 2020 for 6 cycles. Recent scan found 2 more new grouldglass opacities, and also 2 spots on my liver. My oncolocgy told me it is hard to do biopsy on lung and liver. He thought the liver may be from the reaction of Kadcyla, and not cancer, since it didnt change much on the scans. He suggested me to do Tucatinib, Xeloda, and herceptin next. He said if I feel these drugs are strong and want to take a break from chemo, I can do tamoxifen/herceptin since I don't have that much disease. He said we could save all these stronger drugs for when I have more disease. I am confused, I thought Tamoxifen is for ER+, and i am ER-. Does anyone take Tamoxifen with ER-? What are your sife effects with the combo Tucatinib, Xeloda, and Herceptin? I am concerned that I may run out of my option. What are other treatment options for ER-/PR-/HER2+. It seemed like so far meds I was on only worked for a short time :(. Thank you all. Best wishes to all of us.



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  • Bestbird
    Bestbird Member Posts: 2,818
    edited October 2020

    You are correct - Tamoxifen is prescribed solely for ER and/or PR positive patients, and should not be prescribed if both ER and PR are negative.

    Below is a list from my book, "The Insider's Guide to Metastatic Breast Cancer" (which is also available as a complimentary .pdf) of FDA-approved treatments for HER2+. ER-/PR- disease. For detailed information about treatments, cutting edge research, and coping with side effects, visit https://www.insidersguidembc.com/about


    First-Line Treatment:

    • A "triplet" combination of Herceptin (Trastuzumab) (or an approved biosimilar, or a subcutaneous injection called Herceptin-Hylecta) along with Perjeta (Pertuzumab) and a Taxane chemotherapy is recommended for first-line treatment unless you have congestive heart failure or significantly compromised left ventricular ejection fraction (since Herceptin and Perjeta can cause heart damage).* Alternatively, Phesgo (an injectable combination of Herceptin, Perjeta, and hyaluronidase-zzxf) can be given with a Taxane.

    Second Line Treatment:

    • Second- (or later-) line therapy may be the combination of Tukysa (Tucatinib) with Xeloda (capecitabine) and Herceptin (or Herceptin Hylecta or a biosimilar).
    • Another option is Kadcyla (TDM-1/Ado-trastuzumab emtansine).

    Third-and Later-Line Treatment Options depend upon what treatments you've previously taken:

    • A third- (or later-) line treatment is Enhertu (Trastuzumab Deruxtecan/DS-8201), which was FDA-approved in Dec. 2019 for HER2-positive MBC patients who have received two or more prior anti-HER2 based regimens in the metastatic setting.
    • Another third- (or later-) line treatment is the combination of Nerlynx (Neratinib) plus Xeloda (capecitabine), which has been FDA-approved in Feb. 2020 for HER2-positive MBC patients who have received two or more prior anti-HER2 based regimens in the metastatic setting.

    Other options include:

    • Kadcyla (if you haven't already taken it and your cancer has progressed during or after HER2-targeted therapy).
    • Herceptin (or Herceptin Hylecta or a biosimilar) with chemotherapy.
    • Herceptin (or Herceptin Hylecta or a biosimilar) with Tykerb (Lapatinib).
    • Tykerb with chemotherapy.
    • Herceptin (or Herceptin Hylecta or a biosimilar) and Perjeta, with or without chemotherapy (if you've previously taken Herceptin and chemotherapy without Perjeta). Alternatively, Phesgo, an injectable combination of Herceptin, Perjeta, and hyaluronidase-zzxf, can be given with or without chemotherapy.
    • Herceptin Hylecta alone (if you've received one or more courses of chemotherapy for MBC).
    • A clinical trial.


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  • mom2LA
    mom2LA Member Posts: 4
    edited October 2020

    Hi BestBird,

    Thank you for your response and info. It is very helpful. I just talked to my onc, and found out that I am on LOW ER+, and he thinks hormone therapy may work. I am debating if I should try the Tamoxifen and Herceptin and save the Tucatinib, Xeloda, and Herceptin combo for later. Do you have any thoughts on this?


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  • BSandra
    BSandra Member Posts: 836
    edited February 2021

    Dear Bev, uh, thanks for finding out - this trial was on my list (it is not that we'd be able to get into it as we are not in US but still). I googled a bit and found something - seems it was suspended because of COVID (Suspended: Action taken by IRBO)! What does IRBO men? Please check this out: https://covid19.bgcarlisle.com/ Whatever that means, it is still very sad clinical trials stop because of this virus:/ Hope they will be able to resume and continue?

    Saulius

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  • dontwantthis
    dontwantthis Member Posts: 44
    edited May 2021

    Hi,

    I am not sure if this is the correct place to post, but hopefully someone will let me know.

    I have updated my treatment, but briefly in 2007 I 2as diagnosed with ER/PR-, Her2 very positive invasive ductal carcinoma (1.6cm, 8 nodes removed but negative).

    I had a lumptectomy, AC (4 rounds), Taxol (6 rounds) a month since a half of rads (done together with the Taxol and Herceptin). Finished meds un May 2008.

    January 2021 did a mammogram, push forward and was diagnosed with the identical cancer, same breast just a bit over from the original tumor).

    March 9th I had a bilateral mastectomy, 2 weeks started the first of my biweekly Taxol (for 12 weeks), followed by 9 months ov Herceptin every 3 weeks). I have expanders and will put in implants.

    So to get to the point, I see many recommendations to follow up with TDM, i am wondering if anyone has a similar situation and ixnor isn't taking it anc why.

    The last words my Oncologist told me last time, I won't need to see you again, we'll look where I am now.

    I don't want to miss out on anything that might stop any further cancer.

    I look forward to hearing from you.



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  • moth
    moth Member Posts: 4,800
    edited May 2021

    dontwantthis, this is the stage 4 metastatic cancer forum so I don't think it's the right place unless you already have metastatic spread.

    I think you need the early stage HER2+ threads in this forum https://community.breastcancer.org/forum/80

    best wishes

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